Urinary tract infections: Can you tell by the smell?

By Vicki Louk Balint | April 4, 2012

Sometimes, you just know your child is sick. I’m not talking about glassy eyes, grouchy voices or refusing dinner.

I’m talking about the way they smell.

A highly developed sense of smell likely evolved over the millennia to warn parents that something is out of kilter, and that seems to remain today.

Foul-smelling urine is often reported as one of the symptoms in children with a urinary tract infection (UTI), but studies investigating this particular symptom have been contradictory as to whether it is true.

In a study published online this week in Pediatrics, researchers surveyed the parents of children who had a urine culture for a suspected UTI to see if they had noticed any odor.

Out of 331 children, smelly urine was reported by parents in 57 percent of children with UTI and in 32 percent of children without UTI.

The conclusion? The reporting foul-smelling urine should raise the suspicions of health care providers of this type of infection in a young child with an otherwise-unexplained fever.

What do parents need to know about UTIs in young children? Richard Engel, MD, a member of the AzAAP and a pediatric hospitalist at Phoenix Children’s Hospital, answered a few questions for RAISING ARIZONA KID via email:

What are the symptoms of UTI in young children?

UTIs in babies and young children are often characterized by fever and vomiting, however, other symptoms are often lacking. As these are symptoms associated with a wide variety of infections (particularly in their earlier stages), clear diagnosis can sometimes be difficult.

What happens if there is a delay in treatment?

If the infection is not treated in a timely manner, especially in the youngest babies under a few months of age, the infection can spread from the urine to the blood, or even spinal fluid.

Luckily, this usually does not occur. Older children may complain of discomfort while urinating but younger children usually cannot voice these symptoms so the infection is discovered after fever and other symptoms develop.

How common are UTIs in young children?

Urinary tract infections are among the most common bacterial infections in infants and young children, affecting 2-5% of all children. In most children, these are isolated infections not associated with other medical problems or long-term consequences.

A small minority of children with a UTI have other problems with their kidneys that make them more likely to have repeated urinary tract infections. Doctors will usually recommend other testing such as an ultrasound of the kidneys in younger children with UTI to make sure there are not reasons to worry about repeated infections.

What are the signs of UTI, and what can parents expect in terms of treatment?

Fever in the first few months of life should be taken very seriously, as this alone could be a sign of UTI, meningitis, or other serious infections. Seek medical attention right away.

If UTI is suspected in children not yet potty trained, expect the need to check the urine using a catheter inserted up the urethra into the bladder for a few seconds–this is the best way of collecting a reliable sample.

Oral antibiotics are usually adequate for treating a UTI, however, children who are vomiting a great deal, are dehydrated, or have signs of more serious illness may require hospitalization to receive IV antibiotics, fluids or other treatments.